LIVING IN A COCOON
(for JF, who put it all in perspective)

"Well, you could stay home and watch TV instead," reflected a colleague as I fretted about my next travel adventure. My father and I are going on safari in June. We're heading to the Okavango Delta in the northwestern corner of Botswana in southern Africa. The game viewing there is superb, and all the charts promise lions, elephants, cheetahs, colorful birds, and everything in between. The fancy coffee table book our safari agency sent us is filled with glossy panoramic photographs of the African bush, and I easily imagined myself in the landscape, free from all worry and bother, waiting only for the next friendly predator to stroll languidly past my tent.

But that was before a friend--a travel nurse--sent me the Botswana package from Travax.com. Travax produces country reports focused on health and safety issues synthesized from data provided by the Centers for Disease Control, the American Academy of Pediatrics, and the World Health Organization. After reading the 42-page document, I wondered why I'd paid for my safari package in full. I also wondered why the photos from the safari agency showed tourists in shorts and sleeveless shirts--didn't they know about malaria? ticks? UV exposure? What about the food and waterborne diseases such as diarrhea, hepatitis A, typhoid, and cholera? Airborne contagious diseases such as polio, influenza, and tuberculosis? Measles, sleeping sickness, and parasites in abundance? And let's not even get started on HIV/AIDS. Turns out Botswana has the second-highest HIV/AIDS infection rate in the world, with an HIV/AIDS prevalence rate among adults of 37% and 33,000 AIDS deaths each year (out of a total population of 1.6 million). For perspective, the HIV/AIDS prevalence rate among adults in the United States is less than 1% (0.6% to be precise), and AIDS deaths reach about 14,000 people each year out of a total population of almost 299 million people. I checked the CIA World Fact Book to make sure Travax wasn't making this stuff up. Don't breathe, don't eat, and definitely don't have sex in Botswana.

Believe you me, I ran to my doctor for a first round of innoculations (DPT and hepatitis A for starters) and for a slough of prescriptions. Because the risk of TD (traveler's diarrhea) is so high--there's bacterial diarrhea and protozoal diarrhea, so if you don't get one, you'll get the other--I came away with three prescriptions just for diarrhea: one for bad diarrhea, a second for really bad diarrhea, and a third for really, really bad diarrhea. Next week, I go to the travel clinic for the second and final round of innoculations (typhoid and polio) and to discuss which of the many malaria profylaxes has a chance in hell to work in Botswana. Turns out African mosquitoes are mutating like crazy and many are resistant to anti-malarial drugs. Great. Does that mean the tubes of 35% DEET cream I bought to slather all over my body and the giant bottle of super-toxic Permethrin I'm supposed to spray on every article of outer clothing before I leave are just an exercise in wishful thinking?

As I was ranting about all this to my sister one evening, she looked at me askance. "How did you miss this stuff?" she asked me. She writes geography books for a living and is just coming off a period of writing specifically about Africa. She loves to relay to me all the statistical data she's gathered on the countries she's writing about, so Mali's human misery index, Uganda's information campaign against AIDS, and guinea worm eradication in Senegal are daily conversational fare between the two of us. I guess I'd missed this stuff because, like most Americans, I live in a cocoon of public health splendor. An Iranian taxi cab driver once told me that the U.S. miracle is its vast and highly effective system of agricultural distribution. Now that I'm going to Botswana, I think it's our ability to manage and protect public health on a grand scale...and still have money left over to go to the movies.